Question

stewp

Will a povidone iodine suppository used a hour or so before a transrectal biopsy, along with the antibiotics they require already, help with mitigating the risk of infection? Would it affect the tests? The radiation center doing the biopsy doesn't mention this option. I read about it somewhere. My GP thought it made sense.

Josephg

You should consult first with the radiation center, if you have not already done so. We are not medical professionals here, so we are not qualified (or authorized) to answer your question.

Other folks here may chime in with the 'non-medical opinions'.

centralPA

There's research that says it makes sense. First I am hearing of it, with your post. Thanks for asking!

https://journals.lww.com/md-journal/fulltext/2021/10150/transrectal_povidone_iodine_efficiency_in_reducing.53.aspx

https://link.springer.com/article/10.1007/s00345-024-04941-2

stewp

Thank you for these links. I'm not sure why PI isn't widely known and accepted.

Old Salt

A transperineal biopsy is safer with respect to infection, but it is probably too late to find a urologist qualified to do that kind.

stewp

Yes. I don't think I have the option. My GP said that Transrectal is more accurate. I'm not sure if that's true or not.

Clevelandguy

Hi,

Never heard of the iodine suppository but I did do a normal suppository before my rectal biopsy. I would do what the facility recommends that is doing your biopsy. Did you have a MRI previous to guide the doctor on where to take samples? If not the doctor will just be taking shot in the dark samples and could miss something. As stated above I am not doctor nor do I play one on TV.

Dave 3+4

stewp

Hi Dave,

I did get an MRI. Two lesions (PIRADS 5 and 4) so that’s where the focus will be. Biopsy date 20 Feb. The nervous wait begins. It’s a longer wait than I had hoped for.

Stew

Oldernow

https://csn.cancer.org/discussion/comment/1719447#Comment_1719447

Hi @stewp

I had 5 transrectal biopsies over a period of 20 years that did NOT find any cancer. One of those many biopsies left me hospitalized for 10 days with sepsis - a serious system wide infection. When my PSA spiked to 20 in 2022, my urologist sent me to Cleveland Clinic for an MRI guided transperineal biopsy that found cancer in areas not accessible to the transrectal. It was a painless procedure due to the use of nitrous oxide to calm you before the doc injected pain medication and proceeded to get many samples for testing.

Based on the biopsy, I had two 6 month Lupron injections and 28 radiation sessions last May and June. My PSA dropped to <.03 (undetectable) and has stayed there. I have had some issues due to the Lupron and radiation that are discussed in my other posts under @Oldernow

A google search found this information that indicates the MRI guided transperineal is the best way to go -

The transperineal prostate biopsy is considered to be more accurate than the traditional transrectal method and is associated with a lower risk of infection: 

• Accuracy - Transperineal prostate biopsies are more accurate than traditional transrectal biopsies. 
• Infection risk - Transperineal biopsies have a lower risk of infection than transrectal biopsies. The hospitalization rate for sepsis after a transperineal biopsy is less than 1%, compared to up to 7% for transrectal biopsies. 
• Standard of care - Some urologists say that the transperineal biopsy should be the standard of care for prostate biopsies. 

During a transperineal biopsy, a doctor uses ultrasound guidance to insert a needle through the perineum and into the prostate. This method allows the doctor to obtain tissue samples from both sides of the prostate without transferring potentially harmful rectal bacteria. 

Good luck on your journey -

@Oldernow

stewp

Thanks for this. I'd have to travel (and pay) to get the Transperineal biopsy.

stewp

Another question. Because I have to wait so long for a biopsy (MRI shows 2 lesions, one large) does it make sense to pay for a PSMA Pet scan first (I can get in quickly)? Would it be able to stage the cancer and bypass a biopsy or would it at least help to target the biopsy?

Clevelandguy

Hi,

Usually PET scans are used to look for cancer spread outside of the Prostate capsule. I would think it would be part of your diagnosis and treatment plan. Check with your doctor team to see what they recommend. Since you had an MRI I would think that data would be used to guide the biopsy.

Dave 3+4

stewp

Thanks Dave. With delay-delay, I'm trying to advocate by jumping in earlier. Of course, I want to ensure there are no mets asap.

Old Salt

https://csn.cancer.org/discussion/comment/1719551#Comment_1719551

I doubt you will be able to get a PSMA PET scan first. It may not have been approved for your situation. It is approved to detect METASTATIC prostate cancer, and it is also (very) expensive (several thousand dollars). If you find out otherwise, I will be glad to change my opinion.

I understand that waiting for another two months will be hard. On the other hand, prostate cancer is typically slow growing. Yes, the last statement isn't going to alleviate your concerns…